System and method for retracting body tissue

ABSTRACT

A method for retracting body tissue providing a retractor system that includes a rail having two opposed widened rail portions separated by a narrowed portion, each widened portion engageable by a separate clamp. The clamps are configured to support the rail to a fixed surface, or to support a surgical device. Each clamp may independently be positioned or slid along the rail to a desired location without interference with a clamp on an opposing widened rail portion. A device clamp is formed of spherical mating portions which enable alignment of a surgical device along six degrees of freedom, and tightenable by securing a single fastener. A retractor blade mount enables an angular and tilting disposition of a retractor blade, as well as remote manipulation of the retractor blade.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 15/695,431 filed on Sep. 5, 2017 which is acontinuation application of U.S. patent application Ser. No. 14/476,466filed on Sep. 14, 2014, which is a continuation application of U.S.patent application Ser. No. 13/419,130 filed on Mar. 13, 2012, which isincorporated in its entirety herein.

FIELD OF THE INVENTION

The invention relates to a system and method for retracting body tissueduring surgery, and in particular, retracting tissue during a surgicalprocedure involving an anterior approach to the spine.

BACKGROUND OF THE INVENTION

An anterior approach, through the abdomen, may be used to treat avariety of spine related disorders, whether inherent, or related todisease or trauma. For example, an anterior lumbar interbody fusion(ALIF) may be performed, where a portion of the annulus fibrosus andnucleus pulposus may be removed, and replaced with a stabilizing device.Alternatively, one or more spine levels may be stabilized by attachmentof a flexible or rigid rod or plate to the exterior of adjacentvertebral bodies.

An anterior approach affords advantages with respect to a posterior, orposterior lateral approach, particularly in that the spinal cord is moreeasily avoided when accessing the vertebral body. However, there areother structures, particularly including veins and nerve branches, whichmust alternatively be carefully avoided. Often, two surgeons participatein an anterior approach to the spine, for example a vascular surgeonprimarily responsible for the approach, and a spine surgeon responsiblefor the corrective spinal procedure.

A retractor moves and or retains body tissue away from a site beingtreated, and facilitates access to the site through or aroundintervening body tissue, for example the peritoneum and its containedstructures. A retractor may be secured to, and supported by, theoperating table, or other structure within the operating theatre.

SUMMARY OF THE INVENTION

In accordance with the disclosure, a retractor system, comprises a framerail having a cross section defining first and second widened sections,each of the first and second widened sections having opposing surfaces,the first and second widened sections separated relative to each otherby a narrowed portion; a supporting frame arm; a frame arm clampconnectable to the frame arm, and having opposed clamping surfaces eachshaped to conformingly engage the opposing surfaces of the first widenedsection, the frame arm clamp further including a connector connectingthe opposed clamping surfaces and configured to move the clampingsurfaces into conforming contact with the opposing surfaces; and atleast one device clamp having opposed clamping surfaces each shaped toconformingly engage the opposing surfaces of the second widened section,the device clamp further including a connector connecting the opposedclamping surfaces and configured to move the clamping surfaces intoconforming contact with the opposing surfaces, the at least one deviceclamp slideable along the second widened section when the at least onedevice clamp is conformingly engaged with the second widened section andmovable past the frame arm clamp when the frame arm clamp isconformingly engaged with the first widened section.

In various embodiments, the frame rail is provided in separablesections; the separable sections are joinable one to the other to form acontinuous frame rail of a desired length; the separable sections eachinclude one end forming a projection, and an opposite end forming arecess, the projection of one section positionable within a recess ofanother section, to thereby join separable sections into a continuousframe rail.

In other embodiments, the continuous frame rail forming an unobstructedsurface along which at least one of the at least one frame arm clamp orat device clamp may slide continuously along the length of thecontinuous frame rail when conformingly engaged with the frame rail; theprojection includes a circumferential groove, and the recess includes arotatable bolt including a channel sized and dimensioned to receive atleast a portion of the projection and mateably engage thecircumferential groove within the channel; the device clamp includes atightening fastener, and wherein the device clamp is configured toconformingly engage a surgical device and enable positioning of thedevice along six degrees of freedom, and after positioning the device,to secure the device and substantially prevent further movement of thesurgical device upon tightening of only the tightening fastener; and thedevice clamp includes a plurality of mating surfaces defining sphericalportions; the device clamp substantially prevents further movement ofthe surgical device and clamps to the frame rail upon tightening of onlythe tightening fastener.

In yet further embodiments in accordance with the disclosure, theretractor system further includes a retractor blade holder including: anextension having first and second opposed ends connectable to the deviceclamp; a mounting portion at the first end configured to support aretractor blade; and a rotatable element disposed adjacent the secondend configured to enable movement of the mounting portion and attachedretractor blade.

In another embodiment, a retractor system for body tissue comprises aframe rail having a cross section defining first and second widenedsections, each of the first and second widened sections having opposingsurfaces, the first and second widened sections separated relative toeach other by a narrowed portion; a supporting frame arm connectable toa surface that is affixable relative to the body tissue; a frame armclamp connectable to the frame arm, and having opposed clamping surfaceseach shaped to conformingly engage the opposing surfaces of the firstwidened section, the frame arm clamp further including a connectorconnecting the opposed clamping surfaces and configured to move theclamping surfaces into conforming contact with the opposing surfaces byrotating a nut; and at least one device clamp having opposed clampingsurfaces each shaped to conformingly engage the opposing surfaces of thesecond widened section, the device clamp further including a connectorconnecting the opposed clamping surfaces and configured to move theclamping surfaces into conforming contact with the opposing surfaces,the at least one device clamp slideable along the second widened sectionwhen the at least one device clamp is conformingly engaged with thesecond widened section, the at least one frame arm clamp and the atleast one device clamp movable past each other along the frame rail whenthe at least one frame arm clamp is conformingly engaged with the firstwidened section and the at least one device clamp is conforminglyengaged with the second widened section.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and theadvantages and features thereof, will be more readily understood byreference to the following detailed description when considered inconjunction with the accompanying drawings wherein:

FIG. 1 depicts a retractor system in accordance with the disclosure;

FIG. 2 depicts the retractor system of FIG. 1 connected to an operatingroom table;

FIG. 3 depicts the table arm clamp of the system of FIG. 1;

FIG. 4 depicts the frame arm clamp of the system of FIG. 1;

FIG. 5 depicts an hour-glass cross section of the frame of FIG. 1;

FIG. 6 depicts an alternative cross section of a frame of thedisclosure;

FIG. 7 depicts a frame having a cross section in accordance with FIG. 6;

FIG. 8 depicts the frame of FIG. 1, separated into sections;

FIG. 9 depicts a detailed view of assembled frame sections of the frameof FIG. 1;

FIG. 10 depicts a cross section through the center of the frame of FIG.1, taken along the longitudinal axis of the frame;

FIG. 11 depicts a perspective view of a projecting portion of a sectionof a frame in accordance with FIG. 1;

FIG. 12 depicts a linear section of a frame insertable within the frameof FIG. 1;

FIG. 13 depicts a portion of the retractor system of FIG. 1, including adevice clamp connected to the frame, a blade assembly connected to thedevice clamp, and a retractor blade connected to the blade assembly, allin accordance with the disclosure;

FIG. 14 depicts the device clamp of FIG. 13;

FIG. 15 depicts a schematic cross section of a device clamp in themanner of FIG. 14;

FIG. 16 depicts a blade assembly in accordance with FIG. 13;

FIGS. 17-18 depict alternative dispositions of a blade mount inaccordance with FIG. 13;

FIG. 19 depicts a top view of the blade assembly of FIG. 13, togetherwith a retractor blade in an aligned position;

FIG. 20 depicts the blade assembly of FIG. 19, with the retractor bladein an angled position;

FIG. 21 depicts a retractor blade of the disclosure, including an offsetmount for a fastener;

FIG. 22 depicts a retractor blade of the disclosure, including acentrally aligned mount for a fastener, and an assembled fastener;

FIG. 23 depicts an alternative retractor blade of the disclosure,including a central assembly slot; and

FIG. 24 illustrates a retractor blade including a light source assembledinto a central slot of the disclosure.

DETAILED DESCRIPTION OF THE INVENTION

As required, detailed embodiments are disclosed herein; however, it isto be understood that the disclosed embodiments are merely examples andthat the systems and methods described below can be embodied in variousforms. Therefore, specific structural and functional details disclosedherein are not to be interpreted as limiting, but merely as a basis forthe claims and as a representative basis for teaching one skilled in theart to variously employ the present subject matter in virtually anyappropriately detailed structure and function. Further, the terms andphrases used herein are not intended to be limiting, but rather, toprovide an understandable description of the concepts.

The terms “a” or “an”, as used herein, are defined as one or more thanone. The term plurality, as used herein, is defined as two or more thantwo. The term another, as used herein, is defined as at least a secondor more. The terms “including” and “having,” as used herein, are definedas comprising (i.e., open language). The term “coupled,” as used herein,is defined as “connected,” although not necessarily directly, and notnecessarily mechanically.

With reference to FIGS. 1-2, in accordance with the disclosure, aretractor system 100 includes one or more each of the following: tablearm 110, table arm clamp 120, a frame arm 130, a frame arm clamp 140,and frame 150. System 100 may include a table clamp 200, or may becombined with a known table clamp. For example, table arm 110 may beshaped, sized, or dimensioned to be used with any of a Clark socket,side rail socket, allen clamp, or universal clamp. Table clamp may beattached to an operating room table 202, as shown, or any otherfurnishing or structure in the operating theatre.

A patient, not shown, is positioned with a portion of the patient's bodypositioned adjacent frame 150, for example underneath frame 150. In thismanner, frame 150 is advantageously located proximate a surgical site,to provide support for surgical tools or equipment, described furtherbelow. System 100 may additionally provide support for a portion of amedical practitioner's body, for example to steady a surgeon's hands.

Table arm 110 is advantageously formed as an elongated extension,slidingly received within table clamp 200, so that it may be securedwithin table clamp 200 at any position along table arm 110, therebydefining a distance and disposition of table arm clamp 120 with respectto table clamp 200. As table clamp 200 is positioned in a fixed positionwith respect to the operating theatre, a disposition of table arm clamp120 is established with respect to the operating theatre; for example, aheight of table arm clamp 120 may be adjusted and set with respect to afloor of the operating theatre.

Table arm 110 is advantageously provided with a segmented curved portion112, whereby a table arm clamp 120 may be slidingly and rotatablypositionable anywhere along a first axis defined by a first portion 114of table arm 110, for example along a vertical axis relative to anoperating table 202, or be positionable anywhere along a second axisdefined by a second portion 116 of table arm 110, for example along anaxis that is coplanar with operating table 202. Table arm 110 mayfurther be rotated within table clamp 200, whereby the second portion116 may be oriented at any angle relative to the first portion 114.

Table arm clamp 120 is detailed in FIG. 3, in which it may be seen thattable arm 110 and frame arm 130 are rotatable within table arm clamp 120about axis “A” and “B”, in collars 122, 124, respectively. Frame arm 130may further be pivoted with respect to table arm 110 about axis “C”,about pivot 126. A clamp handle 128 may be used to tighten collars 122,124, and pivot 126, for example by engaging threaded or cammed surfaces,not shown. Frame arm 130 is affixed to operating room table 200 or otherobject which is likewise affixable relative to body tissue of thepatient, using any known or hereinafter developed means.

Frame arm 130 is advantageously formed as an elongated extension,slidingly and rotatably positionable within table arm clamp 120. A frame150 is affixed to one or more ends of frame arm 130, or anywhere along alength of frame arm 130, using frame arm clamp 140.

With reference to FIG. 5, frame arm clamp 140 is configured to mateablyengage frame 150. FIGS. 6-7 illustrate sections of two alternate forms,150A and 150B, of frame 150. Each of frame 150A and 150B formsrelatively wide and narrow portions, 152, 154, which form an hour-glassshape, the widened sections separated from each other by a narrowedportion. Frame arm clamp 140 includes opposed clamping surfaces, orrecesses 142A, 142B, which may be moved relatively apart and together,and into which opposing surfaces of wide portion 152 of frame 150 may beinserted. Alternate form 150A of frame 150 may have wide portion 152Ainserted within recesses 142A, 142B, for example by inverting frame 150,or rotating frame arm clamp upon frame arm 130, to receive wide portion152A.

To retain inserted frame 150 within frame arm clamp 140, mating clampingportions 144A, 144B are moved together to securely bind frame 150through a mating engagement of recesses 142A, 142B with widened portion152 or 152A. Clamping portions 144A and 144B are mutually connected by aconnecting portion, depicted as frame arm 130, although a separateconnector may be provided, connected to frame arm 130. To provideleverage and maintain a binding force, a lever 146 may be appliedagainst one or both of clamping portions 144A, 144B, lever 146 movingagainst clamping portion 144A or 144B through movement due to engagementof threaded surfaces 148, as shown, or through interaction of cammedsurfaces (not shown), or other mechanical means. In the embodiment ofFIG. 5, clamping portion 144A is fixed upon frame arm 130, and clampingportion 144B slides upon frame arm 130 as lever 146 applies a movingforce thereto.

In FIGS. 8-9, frames 150A and 150B are shown, wherein frame 150B isillustrated as a unitary part, having spaced apertures 156 therethrough,and frame 150A is shown without apertures 156, and divided into sections158A and 158B. It should be understood, with reference to the followingdiscussion, that either frame 150A or 150B may be provided with eitheror both of apertures, or divisible portions.

Apertures 156 are advantageously provided as an alternative oradditional method for securing frame 150 to frame arm clamp 140, or toanother device, whereby a fastener 194, for example a threaded fasteneror clip, may be passed through aperture 156 to form a connection.

FIG. 9 illustrates a form of frame 150 which may is separable into aplurality of portions, whereby a dimension of frame 150 may be increasedor decreased as needed by the medical practitioner. A connection 160 isformed between sections of frame 150. As will be understood further inthe discussion of attached devices, below, it is advantageous to avoid aprojection or perturbation upon the exterior surfaces of frame 150. Afastener, such as a threaded screw (not shown), or fastener 170, may bepassed through section 158A, to engage a projection 164 of section 158B,to thereby fasten sections 158A and 158B together.

FIGS. 10-12 detail a manner of connecting frame 150 sections 158A and158B, in accordance with the disclosure. A grooved post 166 extends fromprojection 164, and may be inserted into a post aperture 168 in frame150, as illustrated, or may be continuously formed from material offrame 150. A bolt 170 is insertable within a bolt aperture 172 formed insection 158A. After bolt 170 is inserted into bolt aperture 172, a splitring or pin 174 is inserted into an opening in section 158A to engage agroove 176 formed upon bolt 170, to thereby rotatably retain bolt 170within bolt aperture 172. A channel 176 having an enlarged opening 178is formed in a side surface of bolt 172 of sufficient size and dimensionto pass an end portion of post 166 into an interior of bolt 172. As bolt170 is rotated, through interaction of tool engaging recess 180,circumferentially extending channel 176 narrows to mateably connect andengage post groove 182 and thereby secure frame sections 158A and 158Btogether. Projection 164 provides further stabilization and support,conformingly engaging a mating receptacle 184 in section 158A. It shouldalso be understood that frame sections may be joined by a threaded screw194, as illustrated in FIG. 13.

In accordance with the disclosure, sections of frame 150, for examplesections 158A and 158B, extension 190, or segments having differentshapes than these examples, may be joined together to form a continuousrail of any length or shape, to suit the needs of the medicalpractitioner. The unobstructed surface 192 of frame 150, includingextensions, enables the positioning of frame arm clamps 140 and deviceclamps 300, or other frame rail attachments, anywhere along the lengthof the joined segments or extensions.

With reference to FIG. 12, a frame extension 190 is formed withconnection 160 components at each end, with one end matching theconnection 160 components of frame section 158A, and the other endmatching the connection 160 components of frame section 158B. In thismanner, two frame extensions 190 may be interposed between framesections 158A and 158B, to increase a linear length of a supportingsurface 192 of frame 150. Frame extension 190 is illustrated as a linearform in FIG. 12, although other forms, including curved forms, may beprovided, to form a frame having any of a wide variety of sizes andshapes. It should further be understood that frame sections 158A and158B may be provided with ends formed in the manner of frame extension190, wherein one end includes projection 164, and the opposite endincludes bolt aperture 172. In this manner, sections 158A and 158B maybe identical, and may be used as extensions, as well.

Referring now to FIGS. 13-15, system 100 includes a device clamp 300operative to securely hold a device with respect to frame 150 at aparticular desired angular disposition. Device clamp includes a mountingbase 302 comprising opposed clamping surfaces, or recesses 304A and304B, which are sized and dimensioned to engage widened portion 152 offrame 150, and are disposed upon separable device clamping portions 306Aand 306B. In one embodiment of the disclosure, device clamping portions306A and 306B are driven together to clamp frame 150 in the manner ofclamping portions 144A and 144B, securing frame arm 130, as illustratedin FIG. 5. In the embodiment illustrated in FIGS. 14 and 15, anelongated fastener 308 draws ramped clamping surfaces 310A and 310Bagainst a complementary surface, driving device clamping portions 306Aand 306B towards each other, and thereby reducing a distance betweenrecesses 304A and 304B, to grasp frame 150. An extending surface 312 maybe provided to increase leverage and a range of movement of deviceclamping portions 306A, 306B. An additional ramped surface 314 may beformed within an interior of device clamping portions 306A, 306B, in theembodiment shown complementary to a nut 316. it should be understood,however, that nut 316 may be positioned at an opposite end of fastener308. FIG. 15 illustrates the device clamp of FIG. 14 schematically, in across-section through a central longitudinal axis of blade handle clamp300.

In accordance with the disclosure, when device clamp 300 and frame armclamp 140 are both assembled onto frame 150, they may each be movedindependently past the other without mutual interference. Moreparticularly, device clamp 300 may be conformingly engaged with widenedportion 152, and frame arm clamp 140 conformingly engaged with widenedportion 152A, and if either or both are not fully tightened to beimmovable, they may be slid along frame 150 to a desired location,without interference or impediment to movement of the other, after whichthey may be tightened to secure against further movement. It shouldfurther be understood that device clamp 300 may alternatively beconnected to widened portion 152A, and frame arm clamp 140 connected towidened portion 152, with a similar lack of mutual interference withrespect to frame rail 150.

One or more blade handle clamps 320 extend from device clamp 300,operative to support a blade assembly 400, and advantageously, a bladehandle 402. In FIG. 14, blade handle clamp 320 is shaped to form ashaped opening which can be closed to securely and conformingly graspblade handle 402. In one embodiment, the shape is circular orcylindrical, so that blade handle 402 may be rotated within a loosenedblade handle clamp 320, and then secured at any angular disposition whenblade handle clamp 320 is tightened. As may be seen in FIG. 15, bladehandle clamp 320 is formed with separable blade handle clamping portions324A, 324B, which may be drawn together in the manner shown in FIG. 5.Alternatively, as illustrated in FIGS. 14-15, fastener 308 forms a clampwhich passes through blade handle clamping portions 324A, 324B and isoperative to apply a compressive force to opposed external surfaces ofportions 324A, 324B, thereby drawing the portions together to grip bladehandle 402.

Fastener 308 may be rigid, or is advantageously flexible, to increase arange of angular disposition of device clamp 300. A fastener handle 326,shaped to be grasped by the gloved hand of a medical practitioner,extends from an end of fastener 308. In the embodiment illustrated,fastener handle 326, blade handle clamping portions 324A and 324B, anintermediate spacer 328, and blade assembly portions 306A, 306B areprovided with rounded surfaces complementary to adjacent surfaces, forexample spherical portions, so that a constant or predictable amount ofsurface area engagement is maintained regardless of an angulardisposition of these elements with respect to each other. A toolengagement aperture 330 is provided to matingly engage a driving tool,handle, or lever (not shown) for tightening fastener 308. In accordancewith the foregoing, device clamp 300 enables engaging a surgical deviceand positioning of the device along six degrees of freedom, moreparticularly forward/backward, up/down, left/right (translation in threeperpendicular axes) combined with rotation about three perpendicularaxes (pitch, yaw, roll), and after positioning the device, to secure thedevice and substantially prevent further movement of the surgical deviceupon tightening of only one tightening fastener 308.

It should be understood that any clamped surfaces of the disclosure maybe knurled, roughened, or textured, in order to promote a stable clampedconnection.

With reference to FIGS. 16-24, blade assembly 400 includes blade handle402, adjustment knob 404 rotatably mounted to a first end of handle 402,and a blade mount 406 pivotally mounted to an opposite end of bladehandle 402, at pivot 408. A mounting post 410 supports one or moreblades 500, and is advantageously provided with a quick releasemechanism, for example a ball lock with actuating button or pin, or aspring loaded ball (not shown). Other blade attachment mechanisms may beused, as currently known and understood within the art, or ashereinafter invented.

As may be seen in FIGS. 19-20, a blade 500 is pivotally mounted tomounting post 410, so that an angular disposition of blade 500 may beachieved, with respect to handle 402. In one embodiment, blade 500 isprovided with a blade mounting aperture 502. Alternatively, mountingpost 410 may be an aperture, and blade mounting aperture 502 may be apost. A locking mechanism is provided to secure blade 500 at aparticular angular orientation. For example, a tool engaging threadedconnector 412 may be associated with mounting post 410, or blade 500.Alternatively, mounting post 410 may be provided with a splined surface,mateably engageable with blade mounting aperture 502, so that blade 500may advantageously be inserted at a desired angular disposition, whichangle is maintained by the splined engagement.

In FIG. 16, a movable coupling 414 is pivotally connected to an offsetpivot 416, which is connected to pivot 408. As movable coupling 414 ismoved forward or rearward axially with respect to handle 402, offsetpivot 416 is caused to rotate radially with respect to pivot 408,thereby changing a tilting angle of blade mount 406 with respect tohandle 402. In the embodiment shown, the tilting angle is at 90 degreeswith respect to the angular disposition obtainable by the connection ofmounting post 410 and blade mounting aperture 502. In the embodiment ofFIG. 16, movable coupling 414 is caused to move through a threadedconnection 418, formed between an end of movable coupling 414 and athreaded portion 420 connected to adjustment knob 404. Adjustment knob404 is rotatably mounted to handle 402, whereby rotation of adjustmentknob 404 in a first direction rotates threads of threaded connection 418to draw movable coupling in a direction towards adjustment knob 404,thereby pulling upon offset pivot 416, which functions as a leverpivoting upon pivot 408 to tilt blade mount 406. Turning adjustment knobin a second direction causes an opposite movement of offset pivot 416and blade mount 406. In use, it may be advantageous to position allcomponents of retraction system 100, with blade 500 contacting bodytissue to be retracted, after which adjustment knob 404 is rotated tocause blade mount 406 to pivot, and to thereby cause attached blade 500to move body tissue away from an access site.

Although threaded connection 418 is illustrated nearer to blade mount406 than adjustment knob 404, threaded connection 418 could be locatedanywhere along handle 402, including within an interior of adjustmentknob 404. Additionally, instead of threads, threaded connection 418 mayuse ramps, cams, or other methods of causing movement of movablecoupling 414, and may further include an electric or hydraulic actuator.

Linkage 422 may advantageously be provided, connected between offsetpivot 416 and movable coupling 414, to increase a range of motion ofblade mount 406, and or to decrease a size of blade assembly 400. In theembodiment shown, linkage 422 includes a linkage pivot 424, and a linkextension 426 pivotably mounted to offset pivot 416 and linkage pivot424.

Referring now to FIGS. 21-24, a blade 500 is sized and dimensioned tomove and or retain body tissue in a desired location. Blade 500 may haveany size and shape that is known or hereinafter is found to have atherapeutic purpose, including as examples long, short, wide, narrow,trapezoidal, concave, convex, odontoid, and Harrington, Deaver,Yu-Holtgrewe, and Carol. Typical sizes include, as examples, widthsbetween 16 and 50 mm widths, and lengths between 40 and 220 mm, althoughblade 500 may be substantially narrower, wider, shorter, or longer,dictated only by the needs of the medical (including veterinary)practitioner. A shaped tip may be provided to more securely engagebodily tissue or structures, and blade 500 may be malleable, so that anoptimal conformity with body tissue or surgical equipment may beachieved. Blade 500 may be formed of any biocompatible material,including a polymer or metallic material, including, as examples, highmolecular weight polyethylene or titanium, stainless steel, or aluminum.

In the embodiment shown in FIG. 21, a fastener bracket 504 is positionedoffset from a longitudinal centerline of blade 500. In FIG. 22, bracket510 is positioned centered with respect to a longitudinal centerline ofblade 500. A channel 506 formed within bracket 504 or 510 supports afastener 508, as illustrated in FIG. 22. In one embodiment, bracket 504is hinged, so that channel 506 may be moved with respect to alongitudinal centerline of blade 500. Alternatively bracket 504 may befixed to a left or right of a centerline of blade 500. Accordingly, amedical practitioner may choose a blade having a channel 506positioning, or may reposition channel 506, to align a supportedfastener 508 with an appropriate structure within the body, suitable forreceiving fastener 508, including as an example, a vertebral body.

FIG. 23 illustrates an alternative blade 500 shape, and furtherillustrates an elongated slot 512 through which body tissue may beviewed, and to which additional devices may be attached. FIGS. 21-22illustrate attachment of brackets 504 or 510, and in FIG. 24, a lightemitter 514 has been attached. Light emitter 514 may be provided with aninternal power source, or may be connected to an electrical source witha cable 516. In other embodiments, a camera, suction device, or othertool is positioned and connected in the manner of light emitter 514.Light emitter 514 or other device may further be provided with amounting bracket (not shown) which enables positioning of an attacheddevice in connection with blade 500, irrespective of a position of blade500.

The assembled components of retractor system 100 are thus adapted toprovide movement of blade 500 in all degrees of freedom, in order toprovide an advantageously optimal approach and trajectory into the bodyfor surgical instrumentation, improving exposure for instrumentation andmanipulation, and for location and placement of body tissue with highprecision, while minimizing trauma.

It will be appreciated by persons skilled in the art that the presentinvention is not limited to what has been particularly shown anddescribed herein above. In addition, unless mention was made above tothe contrary, it should be noted that all of the accompanying drawingsare not to scale. A variety of modifications and variations are possiblein light of the above teachings without departing from the scope andspirit of the invention.

All references cited herein are expressly incorporated by reference intheir entirety. In addition, unless mention was made above to thecontrary, it should be noted that all of the accompanying drawings arenot to scale. There are many different features to the present inventionand it is contemplated that these features may be used together orseparately. Thus, the invention should not be limited to any particularcombination of features or to a particular application of the invention.Further, it should be understood that variations and modificationswithin the spirit and scope of the invention might occur to thoseskilled in the art to which the invention pertains. Accordingly, allexpedient modifications readily attainable by one versed in the art fromthe disclosure set forth herein that are within the scope and spirit ofthe present invention are to be included as further embodiments of thepresent invention.

What is claimed is:
 1. A retractor system comprising: a frame railhaving opposing surfaces; a supporting frame arm configured to becoupled to the frame rail; a frame arm clamp connectable to the framearm and configured to clamp the supporting frame arm to the frame rail;and at least one device clamp having opposed clamping surfaces eachshaped to engage said opposing surfaces of said frame rail, said atleast one device clamp further including a connector connecting saidopposed clamping surfaces and configured to move said clamping surfacesinto contact with said opposing surfaces, said at least one device clampslideable along said frame rail when said at least one device clamp isengaged with said frame rail; wherein said separable sections eachinclude one end forming a projection, and an opposite end forming arecess, the projection of one section positionable within a recess ofanother section, to thereby join separable sections into a continuousframe rail wherein the continuous frame rail forming an unobstructedsurface along which the frame arm clamp and the at least one deviceclamp are moveable past each other and may slide continuously along thelength of the continuous frame rail when engaged with said frame rail.2. The retractor system claim 1, wherein said frame rail is provided inseparable sections, and said separable sections each include one endforming a projection, and an opposite end forming a recess, theprojection of one section positionable within a recess of anothersection, to thereby join separable sections into a continuous framerail, and said separable sections are joinable one to the other to forma continuous frame rail of a desired length.
 3. The system of claim 1,the continuous frame rail forming an unobstructed surface along which atleast one of said at least one frame arm clamp or at least one of saidat least one device clamp may slide continuously along the length of thecontinuous frame rail when engaged with said frame rail.
 4. Theretractor system of claim 1, wherein said projection includes acircumferential groove, and said recess includes a rotatable boltincluding a channel sized and dimensioned to receive at least a portionof said projection and mateably engage said circumferential groovewithin said channel.
 5. The retractor system of claim 1, wherein saiddevice clamp includes a tightening fastener, and wherein said deviceclamp is configured to engage a surgical device and enable positioningof the device along six degrees of freedom, and after positioning thedevice, to secure the device and substantially prevent further movementof the surgical device upon tightening of only said tightening fastener.6. The retractor system of claim 5, wherein said device clamp includes aplurality of mating surfaces defining spherical portions.
 7. Theretractor system of claim 5, wherein said device clamp substantiallyprevents further movement of the surgical device and clamps to saidframe rail upon tightening of only said tightening fastener.
 8. Theretractor system of claim 1, further providing a retractor blade holdercomprising: an extension having first and second opposed endsconnectable to said device clamp; a mounting portion at said first endconfigured to support a retractor blade; and a rotatable elementdisposed adjacent said second end configured to enable movement of themounting portion and attached retractor blade.
 9. A retractor systemcomprising: a frame rail having opposing surfaces; a supporting framearm configured to be affixable relative to the body tissue; a frame armclamp configured to be coupled to said supporting frame arm, wherein theframe arm clamp has opposed clamping surfaces each shaped toconformingly engage said opposing surfaces, said frame arm clamp furtherincluding a connector connecting said opposed clamping surfaces andconfigured to move said clamping surfaces into contact with saidopposing surfaces by rotating a nut; and at least one device clamphaving opposed clamping surfaces each shaped to engage said opposingsurfaces, said device clamp further including a connector connectingsaid opposed clamping surfaces and configured to move said clampingsurfaces into contact with said opposing surfaces, said at least onedevice clamp slideable along said frame rail when said at least onedevice clamp is engaged with said frame rail, said at least one framearm clamp and said at least one device clamp movable past each otheralong said frame rail when said at least one frame arm clamp is engagedwith said frame rail and said at least one device clamp is engaged withsaid frame rail,
 10. The retractor system of claim 11, wherein saidframe rail is provided in separable sections joinable one to the otherto form a continuous frame rail of a desired length, and wherein saidseparable sections each include one end forming a projection, and anopposite end forming a recess, the projection of one sectionpositionable within a recess of another section, to thereby join saidseparable sections inot the continuous frame rail.
 11. The retractorsystem of claim 11, wherein said separable sections are joinable one tothe other to form a continuous frame rail of a desired length.
 12. Theretractor system of claim 11, wherein said separable sections eachinclude one end forming a projection, and an opposite end forming arecess, the projection of one section positionable within a recess ofanother section, to thereby join separable sections into a continuousframe rail.
 13. The retractor system of claim 12, said continuous framerail forming an unobstructed surface along which at least one of said atleast one frame arm clamp or at least one of said at least one deviceclamp may slide continuously along the length of the continuous framerail when engaged with said frame rail.
 14. The retractor system ofclaim 12, wherein said projection includes a circumferential groove, andsaid recess includes a rotatable bolt including a channel sized anddimensioned to receive at least a portion of said projection andmateably engage said circumferential groove within said channel.
 15. Theretractor system of claim 9, wherein said device clamp includes atightening fastener, and wherein said device clamp is configured toconformingly engage a surgical device and enable positioning of thedevice along six degrees of freedom, and after positioning the device,to secure the device and substantially prevent further movement of thesurgical device upon tightening of only said tightening fastener. 16.The retractor system of claim 15, wherein said device clamp includes aplurality of mating surfaces defining spherical portions.
 17. Theretractor system of claim 15, wherein said device clamp substantiallyprevents further movement of the surgical device and clamps to saidframe rail upon tightening of only said tightening fastener.
 18. Aretractor system, comprising: a frame rail, said frame rail formed inseparable portions, each portion including a projecting portion and arecessed portion, the projection portion mateable with the recessedportion to connect the separable portions into a continuous frame railforming an unobstructed surface; a supporting frame arm configured to beaffixable relative to the body tissue; a frame arm clamp coupled to saidframe arm, wherein the frame arm clamp has opposed clamping surfaces toengage said frame rail, said frame arm clamp further including aconnector connecting said opposed clamping surfaces; and at least onedevice clamp having opposed clamping surfaces to engage said frame rail,said at least one device clamp slideable along frame rail, said at leastone frame arm clamp and said at least one device clamp movable past eachother and slidable continuously along said unobstructed surface of theframe rail when said frame arm clamp is engaged with said frame rail andsaid at least one device clamp is engaged with said frame rail.